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hosted by Cyber Civilization Research Center (CCRC), Keio University
co-hosted by Medical Inclusion working group, CCRC
Life Intelligence System Consortium, SFC Research Institute
Value Society Platform Laboratory, SFC Research Institute
WIDE Project
Event Information
Date: Tuesday, October 11, 2022, 13:00-18:00 (Event reception opens at 12:30)
Place: North building Hall, Mita Campus, Keio University
＊Click here to view the program
↓Recording of the seminar
Opening
Introduction
Hitomi Sano, Project Researcher, Member of Cyber Civilization Research Center, Keio University
Keio University was founded by Yukichi Fukuzawa with the aim of pioneering modern Western scientific civilization in the Eastern world. More recently it became an essential base for developing the internet, a prerequisite technology for Cyber Civilization, with the center’s co-directors being generally referred to as the internet’s father and grandfather! It is one of few places where we can objectively look back on the civilization that formed the foundation of our society, while also advancing its direction in the current technological environment.
Combining the internet with all the technologies that form the basis of Cyber Civilization and thinking about what we can do in our unique global space without dividing the digital space will provide significant suggestions on the issues confronting us in medical DX. In particular, those of cost and uneven distribution of medical resources must be expected to be solved globally with the full cooperation of stakeholders. Each separate field cannot independently promote medical DX. Therefore, we must share various themes with meaningful discussions at this seminar.
Organizer’s Greetings
Jun Murai, Professor and Co-Director, Cyber Civilization Research Center, Keio University
I have long focused on how I can contribute to medical and health care while forming worldwide networks based on my computer science background.
I was consulted about the global standardization of SCOT (Smart Cyber Operating Theater), and I learned about the surgical robot system ‘hinotori’ while working at Fujita Health University. I was shocked to find such innovative ways existed in Medical DX.
At the previous seminar, I said, “Health and medical care will lead to DX,” because medical and health care are essential themes for everyone beyond national borders.
How can we cooperate around the world, and how much can Japanese technology contribute to this field? This seminar will be an opportunity to open up the future by combining our various strengths.
Greetings from Keio University
Yuko Kitagawa, Vice President of Keio University
Keio University Hospital has been developing infrastructure and is acting as a model hospital for AI based procedures since 2018.
In 2020, when we celebrated our 100th anniversary, coronavirus began to spread. We became keenly aware at that point that medical DX, including contactless medical care and telemedicine, is extremely important and must be implemented.
Providing guidance and surgical operations remotely has become possible, which should significantly contribute to solving the shortage and uneven distribution of human resources.
From now on, we will focus on preventive medicine. Using a large amount of data in our daily lives before getting an illness is crucial. I hope this seminar will provide important clues for the advance of preventive medicine.
Opening Remarks
Sumio Matsumoto, Honorary Director, National Hospital Organization, Tokyo Medical Center
In 2001, a successful example of remote surgery was carried out across the Atlantic Ocean, over 6,000 kilometers away, using the robotic system ‘Zeus.’ And in 2000, Kyushu and Keio University had already started the clinical trials of ‘da Vinci.’ So, I had high hopes at that time that Japan would finally enter the era of robotic surgery.
However, it was challenging to get insurance to cover robotic operations, and this situation continued for a long time because da Vinci’s sales price in Japan exceeded the world-wide standard price, while cost-effectiveness had become a big argument.
In robotic surgery, the amount of steroid secreted in the operating doctor’s saliva is lower than it is in laparoscopic surgery. This means that the operator feels less stress in robotic surgery. Therefore, we can say from experimental results that surgeons intuitively prefer robotic surgery.
From my experience introducing da Vinci to hospital staff, I believe that surgeons who have experienced robotic surgery, which can be performed while being seated and without wearing a surgical gown, will not be able to return to laparoscopic surgery in reality.
I look forward to today’s discussion of surgical robots.
Session 1: Technology for the Future of Medicine
“What we need in robotic surgery and cyber operation theaters is the digital transformation of surgery”
Kiyoyuki Chinzei, Deputy Director, Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology
I have worked on medical DX projects related to robots and cyber operating theaters for many years. The most challenging part was designing a series of data circulations supporting doctors; how doctors should interact with information systems, including medical equipment.
It is essential for doctors and hospital staff to proactively participate in and discuss ways to determine which part of their workflow should be improved with medical DX.
However, the medical field tends to be cautious about changing existing workflows. Therefore, we must first develop visualization and analysis tools for surgical logs and videos, so medical professionals can quickly analyze logs objectively.
We can utilize surgical information obtained from surgical robots and cyber operating theaters for various public benefits. However, this type of information involves multiple stakeholders: patients, development companies, medical professionals, medical institutions, etc. We must design ways to broadly utilize such information. Besides, we need to be aware that the worldwide development race in this field has already begun.
“Healthcare innovation by DX: Kawasaki and Medicaid vision for the future”
Yasuhiko Hashimoto, President and CEO, Kawasaki Heavy Industries Ltd.
Kawasaki Heavy Industries is a comprehensive manufacturer with a long history in robots. In 2013, we established Medicaroid Co., Ltd., which specializes in medical robots.
Japanese robot manufacturers first visit the site in question and thoroughly listen to the client’s voice. In this way, we have grown with the automobile industry through repeated dialogues with manufacturers. We supply our robots to about 70% of Toyota’s automobile manufacturing plants. Likewise, in developing robots for semiconductor manufacturing equipment, it was inevitable to listen to customers’ needs in detail and have repeated dialogues. Our global share in this field now exceeds 50%.
This attitude toward dialogue is a major reason why Japanese robot manufacturers have done well globally. We can create the best products in the world through these discussions with customers. We indeed utilize the essence of what we have cultivated with industrial robots in the medical field, where it is necessary to reflect the needs of doctors in detail.
We are developing ‘Hinotori,’ a surgical robot originating in Japan and named after ‘Phoenix,’ a story based on the theme of eternal life by Dr. Tezuka. Instead of asking the doctor to change the surgical method, we aim for remote surgery in which the robot reproduces the flexible movements of a human arm in sync with the doctor’s actions.
In addition, MINS (Medicaroid Intelligent Network System) visualizes the surgical process using its large number of logs accumulated by the robot. So we can provide reliable support such as education and monitoring.
Japanese manufacturers account for over half of the world’s industrial robot market. On the other hand, when it comes to medical robots, American-made products are overwhelmingly monopolized, and the current situation is that we rely on imports. Japanese-made medical robots should have many advantages in broadening the skills of Japanese doctors, not only in terms of cost and support.
“SCOT to realize AI surgery”
Yoshihiro Muragaki, Professor, Center for Advanced Medical Engineering Research & Development, Kobe University
I’ve been promoting precision guidance treatment for surgical treatment that has so far been analog. In particular, I’ve been developing the intelligent operating room SCOT (Smart Cyber Operating Theater) that augments the surgeon’s eyes, brain, and place.
AI can learn from the accumulated data by converting analog information, i.e., the empirical knowledge each doctor possesses into explicit digital knowledge. This is what enables AI surgery, i.e., future predictive surgery.
In SCOT, hundreds of medical devices that exist separately in an operating room are packaged and networked. Structured data is generated and synchronized with the times recorded for each device, and tagged in space.
However, companies aren’t highly motivated to synchronize the functions of their medical devices with those of other companies. Therefore, we are creating a global standard ‘OpeLink’ using ORiN (Open Resource Interface for Network), which is widely used in domestic and overseas robotics industries.
We are also developing a motorized operating room, ‘mobile SCOT,’ using 5G communication to perform remote precision guidance treatment at any place where needed.
Session 2: Start-Up Contribution to Medicine and Health
“Taking on the world with Japanese endoscopic AI”
Tomohiro Tada, CEO, AI Medical Service, Inc.
Endoscopies are the only means for early cancer detection, but there is a shortage of highly qualified endoscopists worldwide. Endoscope equipment refers to medical devices that originated in Japan, and Japanese manufacturers have a monopoly of 98% of the global market share. In Japan itself there are many endoscopists, and the equipment is widely used. Therefore a large amount of high-quality data necessary for AI learning is being gathered.
Early detection is the most important way to improve cancer survival rates. AI will search for early cancers that doctors may miss. In addition, although the accuracy of diagnosis varies depending on the experience of doctors, it is possible to raise its level by involving AI.
I started the business of saving patients around the world with endoscopic AI. Gastrointestinal cancer is the leading cause of cancer deaths worldwide. If endoscopic AI was generally implemented in society, it would be possible to save more patients around the globe. Therefore, I want to create a future where endoscopists everywhere are connected to the cloud.
“Developing a healthcare guide for everyone”
Yoshinori Abe, Co-Founder, Ubie, Inc. (Miura)
Our mission is to guide people to appropriate medical care with the aid of our symptom search engine, ‘Ubie’. The number of general consumers making use of it is growing overwhelmingly, with more than seven million people per month.
People can search for appropriate medical institutions according to their symptoms in their own region, and we can send patient information in advance to medical institutions that have registered with the system for free. So, this application leads to early medical consultation for many people.
‘Ubie AI interviews’ for medical institutions have also been introduced at more than 1,100 facilities, reducing waiting times by 1/3 and improving operational efficiency in the medical field.
In the future, we would like to become a platform that connects people with medical care while resolving issues surrounding patients and doctors, including local primary care doctors, and hospitals.
“Current status of AI medical device development in start-ups”
Sho Okiyama, Founder & CEO, Aillis, Inc.
Medical device development is a long and complicated process, requires diverse knowledge, and is costly. The delay in medical DX is due to the division of medical care among different players, a field which has many stakeholders. Therefore, we started our business with cross-disciplinary team building to create genuine medical care that everyone can co-create.
It was a very high hurdle to overcome as a startup, but we managed to beat difficulties such as:
・hardware development
・data collection through specific clinical research
・AI development
・clinical trials
・the regulatory approval process.
We created the first AI medical device as a new medical device category and had it approved for insurance coverage.
We hope that by sharing our case studies and experiences, we can support more start-ups and innovative cases in Japan in the future.
Session 3: The Future of Medicine, Health and Technology in College and Education
“The hinotori™ remote robotic surgery support system via a commercial 5G network – present and future”
Raizou Yamaguchi, Professor, Graduate School of Medicine, Faculty of Medical Sciences, Kobe University
I developed remote surgical support through commercial 5G lines using the Japan-made surgical robot ‘hinotori’, which guides young doctors from afar. This telemedicine can be realized by combining communication and robot technology.
The demand for telemedicine differs between Japan and the world. In Japan, where land is limited and the medical system is well-equipped, the central theme is to support young surgeons with remote robot surgery. On the other hand, a global issue leading to international competition is the technology that enables remote surgery directly to far-flung areas where medical care is unavailable.
Remote robotic surgery has become technically possible, but designing related social systems, such as legal systems, takes more time than the technical side. However, on the technical side, too, connectivity and latency are still concerns. We follow JAXA’s remote control technology as a way to enable the robot to complete surgery when communication is interrupted. Technologies such as low earth orbit satellites and HAPS (high-altitude platform systems), which connect everything wirelessly, can be expected as part of the future in communication.
“Expectations for a novel surgical training platform using Web3-based telesurgical network in the era of robotic surgery”
Koichi Suda, Professor, School of Medicine, Department of Gastroenterological Surgery, Fujita Health University
There are many adverse reports about robotic surgery, but many companies are developing and marketing an endoscopic surgery support robot, seeking new ‘surgical intelligence,’ such as recorded in surgical operation logs obtained from robotic surgery.
Following ICEAGE, robotic surgery spread and developed along with the proctor system in Japan. Facilities pioneering robotic surgery for gastric cancer reported that robots might reduce postoperative complications and improve the survival rate (cancer cure). On the other hand, although robotic surgery has been introduced safely in hospitals, it has yet to reach the point where it can fully draw on its advantages.
No doubt, the benefits of robotic surgery will be widely demonstrated if the concept of appropriate surgery and techniques for mastering robots is passed on by supervising physicians across organizations. As a result, the advantages of expensive robotic surgery will be realized, such as improving patients’ quality of life and survival rates.
The development of a telesurgery platform that enables real-time robotic surgery guidance is indispensable. It should also be seen in conjunction with the following requirements:
・development of Japanese-made robots that can be steadily improved in response to on-site needs
・opening of training facilities where surgical technique training can be conducted using animals and cadavers
・improvement of access to these facilities and dispatch of instructors to sites.
In this way, the environment for training in telesurgical techniques and guidance can be expanded.
Fujita Health University operates multiple robotic surgical training centers and promotes the industry-university collaborative development of ‘hinotori’ itself and a telesurgery platform centered on this system.
In the future, to promote the uniformity of high-quality robotic surgery, it will be necessary to create an environment that efficiently utilizes a large amount of surgical intelligence gathered by robots connected through a remote surgery network using Web3.
“Implementation of IT/AI in healthcare -AI Hospital Project-”
Masahiro Jinzaki, Professor, School of Medicine Department of Radiology and Deputy Director, Keio University Hospital
To promote medical DX throughout Keio Hospital, we aimed to create an organization with a broad base and quick decision-making while determining precise needs. Therefore, each clinical department has a doctor in charge of AI.
First, we worked on digitizing simple work in the hospital. In general, we are promoting the visualization of hospital information and the improvement of services through the use of robots.
In-hospital digitization has led to operational efficiencies, such as visualization of the bed usage status at the command center and visualization of the utilization rate of medical equipment. In addition, the introduction of an AI medical interview system and the provision of digital information to patient smartphones is progressing.
With regard to robots, we have introduced robots that provide hospital guidance and AI wheelchairs for transporting patients. Besides, we found that introducing automatic work dispensing robots can improve the efficiency of allocating work more accurately than humans.
In the future, we would like to utilize the various accumulated data for preventive medicine.
→Click here for the second half of the event report.
(written by Hitomi Sano , photo by Shun Arima)